Provider Demographics
NPI:1902084536
Name:CT BRAVO, INC.
Entity Type:Organization
Organization Name:CT BRAVO, INC.
Other - Org Name:BELTONE HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,
Authorized Official - Phone:706-364-3184
Mailing Address - Street 1:4210 COLUMBIA RD
Mailing Address - Street 2:BLDG. 5, SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0401
Mailing Address - Country:US
Mailing Address - Phone:706-364-3184
Mailing Address - Fax:706-364-3187
Practice Address - Street 1:4210 COLUMBIA ROAD
Practice Address - Street 2:BLDG. 5, SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-364-3184
Practice Address - Fax:706-364-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000775332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment